Question to GP Maarten: Switching to another diabetes medicine?

Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand.

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Dear Martin,

May I ask what you think about switching from Metformin 1500mg/day to Semaglutide (Ozempic) injection 1/week for the treatment of type 2 diabetes?

With a BMI of just over 33 (1.80 m, 108 kg) I wondered if these newer generation diabetes products would be better in my case, the combination weight loss would be a nice bonus.

I have read even better reviews of tirzepatide, but it is probably not yet available in Thailand.

Thanks for the info.

Regards,

P.

****

Dear P,

If you can keep your sugar level with Metformin, I see no reason to switch to a new drug, no matter how good the reviews are. Keep in mind that those reviews are generally made by the manufacturer, who pays well-known cardiologists, if they can put their name under the reviews.

Here's an independent review, in which semaglutide is not (yet) recommended. However, it is not very negative.
https://www.ge-bu.nl/artikel/semaglutide-voor-gewichtsverlies-bij-obesitas?full

Switching won't be easy either. The chance of hypoglycaemia is real during that period. If you switch, make sure you always have glucose or sugar with you.

Back then we had the Avanda (rosiglitazone) scandal. That would prevent heart failure and lower sugar. The sugar did go down, but it actually caused heart failure. 80.000 people died as a result. I've lost several patients because I refused to prescribe it. A complaint was even filed.

Metformin has been on the market since 1975 and was first used in 1957. We know all the side effects of Metformin, including that it has a minor effect on weight. No negative influences have been observed in the offspring, although you should be careful with that.

I hope you now have enough information to make a decision.

Sincerely,

Dr. Maarten

Do you have a question for Maarten and do you live in Thailand? Send this to the editor: www.thailandblog.nl/contact/ It is important that you provide the correct information (see list at the top of the page).